Page 22 - Palliative Care, Trials and COVID-19 Tribulations: First-hand experience shared by the experts at ground zero

Symptom Management in Severe COVID-19

Dyspnoea

Now, I am going to talk about symptom management in severe COVID-19 starting off with
dyspnoea, because it is the commonest symptom that you will face. When we look at
dyspnoea, we need to actually be able to assess the patient to see how comfortable they are or
how distressed they are, and to do that you need to look at the respiratory rate, the use of
accessory muscles, SpO and the heart rate whether they are restless or not.
2,

Figure 13: The scale used for dyspnoea management.

If the patient can actually do a self assessment, you can ask them how breathless they are, on
a scale of zero to ten. Zero meaning no dyspnoea and ten, the worst possible they can
imagine, just like doing a pain score.

For many patients, they may not be able to verbalize, and it is hard for them to understand the
dyspnoea score. For such patients, we can use the non-verbal assessment (Figure 14). This is
a useful tool. It has eight parameters that you can look at and help you to determine whether
someone is very distressed or not, with their breathlessness, looking at the heart rate,
respiratory rate, restlessness, breathing patterns, and how they are looking.